Www.myfloridalicense.com
| |STATE OF FLORIDA |FOR OFFICE USE ONLY |
| |DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION | |
| |2601 Blair Stone Road | |
| |Tallahassee, FL 32399-1011 | |
| |Phone: 850.487.1395 | |
| | | |
| |DBPR/hotels-restaurants/ | |
| | |Complaint # | |
| | |Date Received | |
|Section 1 – LICENSEE Information |
|License Type: | Food Service | Lodging | Elevator | Registered Elevator Company | Elevator Inspector |
| Name |
| |
| Address |
| |
| City | County | Zip Code |
| | | |
| Business Phone | License Number (if known) |
| | |
|SECTION 2 – COMPLAINANT INFORMATION |
|Last Name |First |Middle |Title |Suffix |
| | | | | |
| Organization Name (if representing an organization, please provide the name of the organization) |
| |
|CONTACT INFORMATION |
| Primary Business Phone Number | Primary Home Phone Number |
| | |
| Primary E-Mail Address | Alternate Phone Number or Fax Number |
| | |
| Does the Complainant want to be contacted? | Yes No |
|MAILING ADDRESS |
| Street Address or P.O. Box |
| |
| |
| City | State | Zip Code (+4 optional) | Country |
| | | | |
|Section 3 – Details of the complAInt |
| |
| Please provide any additional comments on an addendum. If addendum is used, please check here |
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